The main problems which afflict the gall bladder are an inflammatory condition known as cholecystitis and the presence of gall stones in the gall bladder. The latter condition is known as cholelithiasis. The former often leads to the latter. Gall stones are usually caused by disturbances in the composition of bile. They are small pebble like substances that develop in the gall bladder.

Causes and symptoms

The main symptom of gall bladder disease is acute or intermittent pain in the abdomen. Indigestion, gas, a feeling of fullness after meals, constipation and nausea are other usual symptoms. Intolerance to fats, dizziness, jaundice, anemia, acne and other lesions may also occur. The main cause of gall bladder disease is excessive intake of refined carbohydrates, especially sugar. Intake of excess calories can also lead to increased cholesterol secretion.

Meals rich in fat may cause an attack of gall bladder pain or gall stone colic. Other causes are chronic constipation, poor health, hereditary factors and stress.

Gall stones usually produce symptoms by causing inflammation or obstruction following their migration to the cystic duct or common bile duct. The most specific and characteristic symptom of gall stone disease is biliary colic. Obstruction of the cystic duct or common bile duct by a stone produces increased intraluminal pressure and distension of the viscus which cannot be relieved by repetetitive biliary contractions.

As gall stones block the bile ducts, it causes an increase in pressure in the gall bladder and causes extreme pain in the upper right quarter of the abdomen, often extending to the back. This is termed as a ‘gall bladder attack’ as they cause suddenly and they are accompanied by nausea and vomiting.

This pain last for few minutes to several hours. The pain may be under the right shoulder or in the back between the shoulder blades.

This resultant visceral pain is characteristically a severe, steady ache or pressure in the epigastrium or right upper quadrant of the abdomen with frequent radiation to the inter scapular area, right scapula or shoulder.

Biliary colic begins quite suddenly and may persist with severe intensity for 1 to 4 hours, subsiding gradually or rapidly. An episode of biliary pain is sometimes followed by a residual mild ache or soreness in the right upper quadrant which may persist for 24 hours or so. Nausea and vomiting frequently accompany episodes of biliary colic and mild elevations of serum bilirubin occur in 25 percent of patients. Persistent of high serum bilirubin level suggests common duct stones. Fever or chills with biliary colic usually imply an underlying complication i.e. cholecystitis, pancreatitis or cholangitis.

Also a few of the people with gall stones have no signs and symptoms and are also unaware of their gall stones. Such stones are termed as ‘silent stones’.

The formation of gall stones is a complex process that starts with bile, a fluid composed mostly of water, bile salts, lecithin (a fat known as phospholipid) and cholesterol.

Most gall stones are formed from cholesterol.

The cholesterol stones form when bile contains too much cholesterol, too much bilirubin, not enough bile salts or when the gall bladder does not empty completely. The reason for these imbalances is not known.

Pigment stones are the second most common type of gall stones. Patients can also have mixture of this two. Pigment stones are formed from a brown colored substance called calcium bilirubinate.

Persons who are at risk for gall stones

• Women are more likely to be affected than men.

• Those who are obese are at a greater risk of developing gall stones.

• The prevalence of the disease raises with age.

• Women, who are pregnant, use hormone replacement therapy and birth control pills.

• People who have a crash diet and lose weight suddenly.

• Sometimes due to hereditary factors.

• Those with diabetes

• One who take cholesterol lowering drugs and

• Those afflicted with Crohn’s disease.

Diagnosis

The presence of gall stones can be determined with the results of a few tests such as the ultrasound or X-ray examination of the abdomen. In case of patients with silent stones the symptoms can appear in their later part of life. Later approximately after a period of five years, approximately 10% of people with silent gall stones can develop the symptoms. Once, if the symptoms develop they are likely to continue and can worsen.

Ultrasonography of the gall bladder is very accurate in the identification of cholelithiasis and has several advantages over oral cholecystography. The gall bladder is usually visualized with the technique and in fact failure to image the gall bladder successfully in a fasting patient correlates well with the presence of underlying gall bladder disease.

Lithotripsy does remain an option for carefully selected patients who wish to avoid surgery.

Diet and other measures

Smaller gall stones can be usually cleared by following proper diet. The patient should follow a well balanced diet, with emphasis on fruits and cooked vegetables. The patient should avoid meat, eggs, animal fats, processed and denatured foods, fried and greasy foods, refined carbohydrates, alcohol, products made with sugar and coffee, as well as spices, condiments and pickles. The patient should eat frequent small meals rather than three large meals.

Exercise is essential as physical inactivity can lead to sluggish function of the gall bladder causing indigestion and ultimately resulting in the formation of gall stones. The Yogic Asanas useful in toning the liver and gall bladder are Sarvangasana, Paschimottasana, Shalabhasana, Dhanurasana and Bhujangasana.

Herbs for Cholelithiasis

The flowers, seeds and roots of chicory or the endive plant are considered valuable in gall bladder disorders. A decoction of 30 ml of the flowers, seeds or roots can be used three times daily with beneficial results in the treatment of this disorder.

The pain of gall stone colic can be relieved by the application of hot packs or fomentation to the upper abdominal area.

Pashana bheda, Gokshura, katuka also posses lithontriptic properties.

Herbal Pack for Cholelithiasis

• Katuki Churna – 1 teaspoon twice daily before meals with water

• Yakritplihantak Churna – 1 teaspoon twice daily before meals with water

• Arogyavardhini Vati – 2 tablets twice daily before meals with warm water